July 1st, 2010

Clinician’s Guide to Evidence-Based Practices: Mental Health and the Addictions

“Clinician’s Guide to Evidence-Based Practices: Mental Health and the Addictions”

By John C. Norcross, Thomas P. Hogan & Gerald P. Koocher

Oxford University Press, Inc.

New York, N.Y., 2008

Psychologists author pocket-sized, practical primer

Reviewed By Paul Efthim, Ph.D.

Most psychologists know about the controversies surrounding evidence-based practice (EBP). In recent years, EBPs have been vilified as simplistic, mindless cookbooks that ignore the complexity of real-world clinical practice while privileging technical factors over the centrality of the therapeutic relationship.

At the same time, no responsible practitioner would argue that we should ignore research evidence in determining what works and what doesn’t. There is broad agreement that clinical practice should be grounded in the best available research integrated with the clinician’s expertise within the context of the particular patient.

But many, if not most mental health and addiction clinicians feel intimidated by the prospect of evaluating the research literature to guide what they do in their day-to-day work. Even some of the most authoritative meta-analytic studies published in mainline journals can seem nerdy and inaccessible.

An innovative pocket-sized primer written by three distinguished psychologists seeks to help practitioners with this problem. “Clinician’s Guide to Evidence-Based Practices” is a handy how-to manual on using research evidence to guide clinical work.

The authors comprise a high-powered trio: John Norcross is one of the world’s foremost psychotherapy researchers, Thomas Hogan is a well-known authority on tests and assessment and New England’s own Gerry Koocher literally wrote the book on ethics (with Patricia Keith-Spiegel) and has served as president of APA, MPA, and NEPA.

Together they present a pragmatic, step-by-step approach to accessing, interpreting and applying research evidence to one’s own practice.

After a brief review of the issues surrounding EBPs, the book focuses on the central task of framing a specific, answerable question prior to seeking out research findings. We learn that clinicians have an average of one to four questions for each 10 patients on their caseload, yet they seldom seek or find answers to these questions. The authors offer a systematic format for asking the right questions that can then be submitted to search engines and other information resources.

Next, the authors offer a critical review of key electronic sources of information, including better-known ones such as PsycINFO and MEDLINE as well as lesser-known sites that focus on evidence-based treatment such as the Cochrane Review and the TRIP database.

Other chapters survey the most common types of research designs and statistics encountered in behavioral research reports. These user-friendly sections defang scary terms such as effect size, factor analysis and many other concepts long since forgotten (or repressed?) from graduate school.

Once one has a handle on the methods and results, how does one critically evaluate researchers’ conclusions? And then how do you integrate research with patient and clinician characteristics? How about ethical considerations when working with EBPs?

Throughout this practical text, Norcross, Hogan and Koocher use several case examples to illustrate how one can answer these important questions while avoiding cookbook approaches. They challenge clinicians to develop a reflective stance that integrates clinical expertise, patient variables and research-based knowledge without sacrificing complexity.

This high-quality book is accompanied by a mini-CD that offers the full text of the book in electronic form with expanded content and hyperlinks to relevant Web resources.

Accessible to both masters- and doctoral-level mental health practitioners, this book is highly recommended. The question remains: will clinicians be willing to go the extra mile to integrate research into their practices? The authors argue that competent, ethical practice necessitates such an effort.

 Paul Efthim, Ph.D. is a licensed psychologist in private practice in Brookline, Mass. and holds a faculty appointment at the Boston Institute for Psychotherapy.

By Paul Efthim PhD

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